Dissertations / Theses on the topic 'Extended scope of practice'
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1
Kristina, Knezevic Harris. "An investigation of the extended application of the Oxford Knee Score in research and clinical practice." Thesis, University of Oxford, 2014. http://ora.ox.ac.uk/objects/uuid:74642889-0433-4ba1-9deb-19be9a9274fd.
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The Oxford Knee Score (OKS) is a popular single summary questionnaire developed to measure the effect of knee replacement surgery from the patients' perspective. There has been a recent interest in the use of the OKS in populations of patients and in roles it has not been originally developed for. To date, no evidence has been provided about the measurement properties of the OKS when it is used outside the context or purpose for which it was originally designed. The general aim of this thesis is to investigate the measurement properties of the OKS when used in extended roles: a) within the population for which the OKS was originally intended and developed for (knee replacement) and, b) when applied on a different population, viz. patients undergoing non-operative treatment for knee osteoarthritis (OA). Four existing large-scale databases of patients undergoing knee replacement surgery and a database obtained from a prospective study on patients undergoing non-surgical management for knee OA were analyzed. The results demonstrate that: 1) it is possible to extract separate information on pain and functional disability from the OKS in a meaningful way (in the form of subscales). 2) For the first time, anchor-based Minimal Important Change (MIC) of 9 points and Minimal Important Difference (MID) of 5 points were established for joint replacement surgery. 3) The OKS demonstrated satisfactory evidence reliability, validity, responsiveness, and interpretability, when used in patients who are undergoing non-operative management for their knee OA. 4) Further evidence of validity was demonstrated by fitting the OKS to the Rasch model. 5) Lastly, it was demonstrated that thresholds can be applied on the OKS to distinguish between patients who consider their knee problem to be severe enough to warrant joint replacement surgery versus patients who do not. This supports the potential use of the OKS in decision making aids for secondary care referral. Overall the thesis provides critical evidence, not previously existing, to support the continued use, and extended use, of the OKS in orthopaedic medicine.
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Benson-Martin, Janine. "The scope of ECT practice in South Africa." Master's thesis, University of Cape Town, 2013. http://hdl.handle.net/11427/2793.
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Includes abstract.Includes bibliographical references.
Electroconvulsive therapy (ECT) involves the administration of an electrical current to the brain in order to produce a tonic-clonic seizure which is deemed therapeutic. It is an effective and safe procedure for the treatment of severe mental illnesses such as major depression, mania and schizophrenia. Currently little is known about the characteristics of ECT practice in South Africa. This study aims to determine current electroconvulsive therapy (ECT) practice and to compare it with reported ECT practice internationally. This is a retrospective, descriptive study, to determine the characteristics of ECT practice in South Africa; data was collected using a self-report questionnaire. The study population consisted of doctors and nurses who practiced ECT in any 12 month period between 2011 and 2012. Both private and state facilities were included in the study. Initially contact was made with hospital mental health facilities to ascertain whether an ECT machine was present on site. Once formal approval was obtained from the appropriate designated bodies, questionnaires were sent to clinical staff involved in ECT at active sites. The 36-item questionnaire covered relevant questions on: utilization rates, equipment, staffing, practice and monitoring parameters, and indications for use. Forty two institutions had an ECT machine on site, of which thirteen institutions reported non-use. Questionnaires were sent to the 29 active ECT sites. Facilities responding to the questionnaire amounted to 83% (n=24), but of these, 21 units responded to the ECT utilization questions. ECT is performed as a modified procedure in six provinces by psychiatrists, registrars, medical officers and general practitioners. In-and outpatient ECT is offered in 79% (n=19) of hospitals. The number of persons treated with ECT/10 000 population per year (ppy) is 0.22 while the number of ECT procedures/10 000 ppy is 1.19. More patients in the private sector receive ECT as a treatment modality than in the public sector (U = 22, p = 0.045). ECT is performed in a minor theatre/operating room in 79% of units, while the rest is performed in a treatment room. All but one unit had a separate recovery room. Informed consent or assent was used in all institutions. Pre-ECT work-up most commonly involved a physical examination (95.5%, n = 21) and basic blood work investigations (87%, n=20). Bilateral, unilateral and bifrontal electrode placements are used, while various dosage- determination and monitoring methods are employed. The vast majority of patients (89.22%, n=869) receiving ECT are between the ages of 18 and 59. The most common indication for ECT is depression (84.77%, n=796). The utilization rate in South Africa is similar to that of countries like Bulgaria, Poland and India, but less than that of some high-income countries. Even though ECT practices in South Africa generally follow international guidelines, standardisation of practice is still recommended.
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Langridge, Neil. "The clinical reasoning processes of extended scope physiotherapists assessing low back pain." Thesis, University of Southampton, 2013. https://eprints.soton.ac.uk/354124/.
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The role of the extended scope physiotherapist has developed relatively recently within health-care. The extended role has utilised the skills of allied health professionals including physiotherapists, and given them autonomy to use knowledge and clinical acumen to request investigations such as Magnetic Resonance Imaging (MRI) as part of the diagnostic process. These requests and processes are delivered outside their traditional scope of practice. Further knowledge on how these practitioners clinically reason is therefore needed as there is little within the literature regarding reasoning in this specific group of clinicians. This research aids in the development of future roles, the governance of services, whilst supporting the training of clinical reasoning for new recruits to this work. This qualitative study has explored the processes by which extended scope physiotherapists clinically reason decisions regarding patients reporting low back pain. The study has used a multiple case study design informed by grounded theory methodology with focus groups and semi-structured interviews as a method to investigate these processes. The themes identified included prior thinking, patient interaction, formal testing, time, safety and accountability, external/internal and gut feeling. Subtle differences in clinical reasoning were seen in the focus group study between ESP and non-ESP clinicians. The processes of clinical reasoning are presented that suggests how these clinicians reason whilst highlighting how they differ to non-extended scope physiotherapists.
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McTaggart, Elizabeth Sarah. "Nurses' experiences of full scope LPN practice in acute care." Thesis, University of British Columbia, 2007. http://hdl.handle.net/2429/32055.
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The practice of licensed practical nurses (LPNs) in acute care in British
Columbia (BC) is undergoing a shift to incorporate the enhanced range of entry-level
competencies introduced by the College of LPNs of British Columbia in
2000. The full range of new LPN competencies, which now constitute full scope,
became a requirement for practical nurse licensure in BC in 2007 and are
challenging LPNs and Registered Nurses (RNs) alike to reexamine and redefine
the LPN role and LPN/RN relations in acute care. Research exploring the
experiences of RNs and LPNs, in their own words, with full scope LPN practice in
acute care staff mixes has not previously been conducted in BC.
This qualitative descriptive study explored the perceptions of 5 RNs and 4
LPNs working in RN/LPN skill mixes, in various Lower Mainland acute care
settings where the LPNs work to full scope. Conventional qualitative content
analysis was used to analyze the data from one in-depth interview and 8 short-answer
surveys. Analysis of one in-depth interview with an LPN yielded 3
categories: professionalism, receptivity, and appropriateness. Analysis of the 8
survey responses from RNs and LPNs yielded 3 categories as well, namely:
defining the role, determining the impact and determining the fit of the role.
Findings in this study indicate that overall, both RNs and LPNs report that clear
communication, LPN role clarity, experience working together over time, and a
supportive work environment contribute to positive experiences of the RN/LPN
skill mix. Feelings of burden, inconsistent teamwork, lack of respect, concerns about
patient acuity levels, and varied perceptions of the ability of LPNs and RNs to
assume responsibility for patient care present areas of challenge in the
workplace.Applied Science, Faculty of
Nursing, School of
Graduate
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Usatine, Richard, Jim Holt, Miranda Lu, and Alexandra Verdieck. "Dermoscopy: Expanding ‘Scope’ of Practice and Preventing Skin Cancer Deaths." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/etsu-works/6446.
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In this hands-on preconference workshop, we will introduce dermoscopy, a proven adjunctive tool that increases sensitivity and specificity of melanoma detection and improves diagnostic accuracy for basal and squamous cell carcinomas. Participants will learn how to use a dermatoscope in clinical practice and learn the two-step algorithm to diagnose unknown skin lesions and determine the need for biopsy. Biopsy techniques will be taught with a handson evidence-based approach that can be applied at one’s home institution. Participants will leave with fundamental competence in the use of dermoscopy for early skin cancer detection, improved understanding of biopsy techniques, tools to train others, free apps, Dermoscopedia, online resources, and online and in-person courses.
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Usatine, Richard, Jim Holt, Alex Verdieck-Devlaeminck, and Miranda Lu. "Dermoscopy: Expanding ‘Scope’ of Practice and Preventing Skin Cancer Deaths." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/etsu-works/6449.
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Community health outreach workers (CHOWs) have been demonstrated to increase CRC screening patient education for vulnerable, medically underserved patients as well as increase CRC screening rates in rural populations.1,2 This project examined the effectiveness of CHOWs in increasing CRC screening rates among low-income, underserved ethnic minorities in Portland, Maine. Eligible patients were ages 50-75; due for CRC screening; enrolled in Medicaid or had no health insurance; and spoke Arabic, English, French, Kinyarwanda, Somali, Spanish or Vietnamese. Seven CHOWs were trained in CRC screening outreach and assigned to patients from their own ethnic communities where they employed culturally sensitive interventions to reduce barriers to CRC screening. CHOWs attempted contact with patients by phone four times prior to sending a language-specific letter to patients recommending CRC screening. CHOWs offered fecal immunochemical testing (FIT) or colonoscopy and provided tailored education and frequent reminders for colonoscopies, explanations about procedures for bowel preps, transportation to colonoscopies, reminders and instructions for FIT completion as well as assistance with health insurance and financial barriers. Upon completion of this session, participants should be able to: Define the role of a community health outreach worker (CHOW) in CRC screening. State three common sociocultural barriers patients experience for CRC screening. Identify the efficacy of CHOWs in increasing CRC screening rates.
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Hoppe, Elizabeth Susan. "Optometry's expanding scope of practice legislation, interprofessional relations, and risk." Ann Arbor, Mich. : University of Michigan, 1999. http://books.google.com/books?id=uxQvAAAAMAAJ.
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Nehring, Wendy M., American Nurses Association, and Nursing Division of the American Association on Mental Retardation. "Intellectual and Developmental Disabilities Nursing: Scope and Standards of Practice." Digital Commons @ East Tennessee State University, 2013. https://dc.etsu.edu/etsu_books/105.
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"Last published in 2004, this new second edition contains up-to-date information for practitioners committed to providing a continuum of services to individuals with intellectual and developmental disabilities (ID/D) across the lifespan." --nursebooks.orghttps://dc.etsu.edu/etsu_books/1111/thumbnail.jpg
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Lucero, Samantha. "Defining the Scope of Practice for Nurse Practitioners in MIAM." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/4074.
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Minimally invasive aesthetic medicine (MIAM) is a relatively new field, which lacks a clearly defined scope of practice. The purpose of this project was to clarify the scope of practice for nurse practitioners in MIAM in California. Without a clearly defined scope of practice, nurse practitioners are unable to practice to the full extent of their license which causes them to be underutilized and face liability issues. This project sought to answer the question: What is the scope of practice of the nurse practitioner in MIAM in the state of California? The model of professional nursing practice regulation was the model used to guide this project. Sources of evidence included case law that has emerged since 1983; reviewing documents from 3 state boards of nursing; and a survey of nurse practitioners who practice in the field of MIAM. The evidence was analyzed noting themes while determining what the legal backbone is for nurse practitioner's scope of practice in California. This project found that nurse practitioners in this field keep up to date in their knowledge, educate their patients, utilize methods to maintain competency, feel support in their environment, assess and refer to others when appropriate, and teach both staff and patients evidence-based practices. It also found that standardized procedures are the legal backbone to understanding the scope of practice in California. A scope of practice was developed based on the findings of this project which was then reviewed by an expert. It is recommended that nurse practitioners utilize their resources to obtain and maintain knowledge as well as learn what the standardized procedures are in their facility. The implications for clarifying the scope of practice will serve this population to fully utilize their capabilities and practice safely, as well as help to develop this relatively new field.
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Finnell, Deborah S., Elizabeth L. Thomas, Wendy M. Nehring, Kris A. McLoughlin, and Carol J. Bickford. "Best Practices for Developing Specialty Nursing Scope and Standards of Practice." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/6707.
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Nursing specialization involves focusing on nursing practice in an identified specific area within the entire field of professional nursing. A defined specialty scope of practice statement and standards of professional practice, with accompanying competencies, are unique to each nursing specialty. These documents help assure continued understanding and recognition of nursing’s diverse professional contributions. The purpose of this article is to demystify the process for specialty nurses who are creating or revising their specialty nursing scope and standards of practice. We provide best practices for the developmental process based on our recently published scope and standards of specialty nursing practice. The conclusion provides strategies to disseminate scope and standards documents to appropriate stakeholders.
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Halliday, Richard. "The transferware engraver : training, practice and scope at the Spode Works." Thesis, Manchester Metropolitan University, 2018. http://e-space.mmu.ac.uk/620679/.
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This investigation focuses on the transferware engraver at the Spode Works. Transfer-printing on earthenware arose as an attempt to replicate the look of eastern ceramics. Spode Works began producing transferware in 1784, and made significant improvements to the process, widening the market across the classes. Transferware patterns could be derived from Chinese-export wares, extant printed images known as source prints, in-house designs or other transferware products. The designs were cut into copper-plates with simple hand-tools by skilled, trained engravers. Prints in underglaze colour were taken from the copper-plates, applied to the blank ware, glazed, and fired to form the product. The research aims were both historical and transformative. (1) To support the preservation of Britain’s largest and most complete archive of hand-engraved copper-plates used in the production of transferware: a repository of craft and design knowledge. The Spode archive contains most of the production plates spanning the factory’s life, 1784 to 2008, and representing all styles and techniques. Due to the intrinsic material value, such archives face rationalisation; the Minton case being known from publication. (2) To ascertain the scope of work undertaken by the engravers and define their role in image selection and adaptation as mediators at the interface between design and production, subjects hitherto insufficiently defined. (3) To define the engravers’ artistic status during key stages of the factory’s life, and to examine their degree of specialisation. (4) To investigate the nature and experience of apprenticeship training for transferware engraving through extant engravings and apprentice’s accounts. Connoisseurship study of archival copper-plates alongside source-work, ceramics and literature formed the basis of the multiple-aspect approach. Within the compass of this thesis, two in-depth case studies are presented that demonstrate surprising continuity in the industry with engraving processes remaining substantially the same over the course of two centuries. The role that the engraver played in working source images or designs into transferware patterns had been poorly understood; it has emerged that the transferware engraver is an intermediary translator of imagery rather than a designer, and authorship in a transferware pattern is multiple. Interviews with those who formerly worked in the industry, documentation of the engraving process from start to finish and a brief personal engraving apprenticeship experience provided detailed primary evidence of engraving from the perspective of the insider. An engravers’ apprenticeship is learning by observation and practice where coordination between tool, hand, eye and brain are internalised. This research expands knowledge of engraving techniques and practices in a specialist area hitherto ignored in the engraving literature. It offers new historical understanding of the role of the engraver as intermediary between design and production. The research points out diagnostic features for understanding the material evidence of copper-plates. Detailed comparisons including micrographic images demonstrate the stratified evidence contained within large object archives (Spode) and small design archives (Mountford tissue pulls), evidence threatened by selective rather than comprehensive retention. It provides thoroughgoing assessment of practical techniques for digitisation and replication of copper-plates so that archive originals can be spared routine handling and security risks. Finally, the research highlights the Spode copper-plate archive as a repository of major importance for the study of craft and design.
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Cafasso, Mandi. "Advocacy: A Vital Step in Attaining Full Practice Authority for the Advanced Practice Registered Nurse." Otterbein University / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=otbn1429220363.
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Bodin, Ida. "Cognitive work analysis in practice : Adaptation to project scope and industrial context." Licentiate thesis, Uppsala universitet, Avdelningen för visuell information och interaktion, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-284334.
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The Cognitive Work Analysis (CWA) framework is widely used by researchers for the analysis of complex systems. It, however, lacks the same impact amongst industrial practitioners. This thesis investigates possible adaptations of the framework to project and industrial constraints, and the consequences associated with such adaptations. Long haul heavy vehicle transportation is the application domain for the work presented in the thesis. The CWA framework has been applied within the Methods for Designing Future Autonomous Systems (MODAS) project. Adaptations have been made to fit the framework within the project constraints and the industrial contexts. Interviews with stakeholders in an industrial organization regarding possible use of models from the CWA framework have been made. The CWA was scaled to available resources when applied within the MODAS project. From this we realized that prioritization of work activity can have consequences on the resulting systems ability to handle unforeseen events. Further, a focus on the current system probed a rapid out-dating of the analysis due to technical development. The conclusion is that even if advantages are lost during adaptation due to practical constraints, the CWA framework could add value to practitioners within industry if adapted to the industrial context.
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Allen, Stephanie. "Establishing the scope of pilates through systematic evaluation: evidence and current practice." Thesis, Ulster University, 2014. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.603526.
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Pilates is an increasingly popular form of exercise that is widely used both within fitness and rehabilitation. There is also a growing evidence-base for Pilates however the authors of previously conducted studies acknowledge numerous limitations which affect the interpretation of the results. Hence the need for future well-designed randomised controlled trials (RCTs) with appropriate target populations, details of the intervention and use of standardised and valid outcome measures. The overall aim of this thesis was to investigate the scope of Pilates through systematic evaluation of current literature and current use of Pilates. This was achieved through exploring and establishing the types of clients attending Pilates classes, their rationale for attendance at classes and the facilitators and barriers to attending Pilates. In addition, clients' perceived effects of Pilates, the timeframe to achieve these effects and the ways in which exercises were planned and progressed in the class setting were also explored and established. This information was then related to the current literature-base to form a basis for recommendations to inform the design of high-quality RCTs. To achieve this, five novel studies were undertaken. The focus groups with Pilates instructors (n=27) and clients attending Pilates classes (n=25) highlighted that Pilates is a method of providing individually-modified and supervised exercises in a group setting for those self-managing long-term musculoskeletal conditions, particularly low back pain. The use of relaxation and education were also deemed to be additional facilitators to clients attending classes. A wide variety of effects were experienced by clients over the period of attendance at classes including reductions in pain, confidence to exercise and improvements in strength, flexibility, body awareness, posture, core stability and balance. However, numerous barriers were also expressed to practicing Pilates including cost, predominately female classes and lack of correction from the Pilates instructor when independently carrying out the exercises. The two large-scale questionnaire surveys of Pilates instructors (n=4201797, response rate 53%) and clients attending Pilates classes (n=762/971, response rate 78.5%) reinforced the findings of the previous focus group studies with Pilates used as an exercise approach for improving overall general health and well-being, in terms of health maintenance and in the rehabilitation of a wide variety of medical conditions, particularly musculoskeletal disorders. A wide variety of effects were again reported with the most prevalent including improvements to posture, core stability, body awareness and sense of well-being. Clients were long-term users of Pilates and the majority reported noticing the overall effect of Pilates from 3-6 months. Facilitators to this long-term attendance included personal adaptation of the exercises in a small group setting and collaborative goal-setting with barriers again including cost and lack of independent practice of Pilates. The final study, a systematic review of literature (n=38 randomised controlled trials) highlighted the potential for a number of positive effects of Pilates across a wide variety of populations particularly those with low back pain, the healthy population and a sedentary/obese population. These included reductions in pain and disability and improvements in strength, flexibility, balance, core stability, function, body composition parameters, general health, psychological effects and on hemodynamic and metabolic parameters. However, due to the numerous limitations in the studies in terms of heterogeneity of the Pilates interventions and lack of standardised outcome measures and control groups, caution must be taken when interpreting the results. In addition, many of the studies were at high risk of bias. Hence, it can be concluded that there is a need for further well-designed research trials to accurately determine the effectiveness of the Pilates method. The findings of the five studies have provided a basis for future recommendations in the design of a high quality RCT.
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Meireles, Matilde. "Extended phonography, expanding field recording through a multi-sensorial practice." Thesis, Queen's University Belfast, 2017. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.727956.
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This research is based on my practice as a field recordist, a graphic designer and a visual artist. It is through an interchange between these three languages that I propose extended phonography, a form of expanding field recording through a plural and multi-sensorial practice that primarily intersects field recording, photography and design. Extended phonography is a site-and-context-specific practice—its multi-sensorial focus on the act of recording is also extended to its presentation making the recordings and their presentation inextricably linked. The strategies developed throughout this thesis provided me with a new insight into the acts of recording, composing and presenting. The final outcomes are still anchored in sound. However through extended phonnography, other nuances of the recorded event are explored in multi-sensory experiences. These experiences transcend the notion of recording as merely a tool for representation and veracity. In extended phonography the acts of recording and the act of presenting these recordings in different spaces, are simultaneously acts of composing. The portfolio of works comprises eight projects: Phragmites australis, Constructing a Soundscape, Sounds of the City, X Marks the Spot, Almost Sound Diary, Som da Mare: urn projecto participativo de arte sonora, and Moving Still. I also introduced some of the ideas behind my interest in—and reservations about—fostering collaboration and participation as catalysts for a shared understanding of place through the projects: Sounds of the City, X Marks the Spot, Almost Sound Diary, and Som da Mare: urn projecto participativo de arte sonora,. This research also presents how the term site, in extended phonography, is used to refer not only to the physical site, but also the contextual, the experiential, and the virtual site.
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Price, R. "Developing practice in radiography and diagnostic imaging." Thesis, University of Hertfordshire, 2007. http://hdl.handle.net/2299/1056.
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An increase in the range and capability of imaging modalities has resulted in greater demands for radiology services. This research investigates how these changes have affected role requirements and role extensions of radiographers and the consequent implications for the educational needs of radiographers. Semi-structured interviews and three successive surveys of NHS radiography managers showed that the adoption and diffusion of extended roles in radiography had increased significantly over a ten year period. Role changes included additions both to the procedures carried out by radiographers, and to the reporting of procedures, e.g. film reporting, once the domain of radiologists, is now undertaken by radiographers in many trusts. Imaging managers’ views on the factors that encouraged or deterred the introduction of extended roles were explored. While many radiographers were keen to adopt new roles, implementation was unlikely without radiological support. Respondents believed the proposed ‘four-tier structure’ would help overcome staffing difficulties, while providing an improved career framework to advance the professional status of radiographers. A key theme was the need for greater clinical knowledge to facilitate transition to advanced practice. Three studies investigated radiography education. The first used a survey to investigate the preparedness for practice of three cohorts of newly qualified radiographers. Graduates recognised the importance of continuing professional development with extended role skills identified as a priority. The second study examined the relationship between contemporary practice and UK undergraduate radiography curricula. Most programmes had responded positively to developing technology. The third study used a survey to investigate the training for extended roles provided by employers. While most provided some training, much was unaccredited, and there was considerable variation in the duration of training for similar roles. The research has documented developments taking place at a time of enormous technological innovation. It provides key data on the changing practice of radiography that will be useful to all stakeholders planning improvements to radiography services. The data lead to a re-definition of practice and recommendations for supporting education and training.
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Buijsman, Stefan. "Philosophy of Mathematics for the Masses : Extending the scope of the philosophy of mathematics." Doctoral thesis, Stockholms universitet, Filosofiska institutionen, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-126252.
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One of the important discussions in the philosophy of mathematics, is that centered on Benacerraf’s Dilemma. Benacerraf’s dilemma challenges theorists to provide an epistemology and semantics for mathematics, based on their favourite ontology. This challenge is the point on which all philosophies of mathematics are judged, and clarifying how we might acquire mathematical knowledge is one of the main occupations of philosophers of mathematics. In this thesis I argue that this discussion has overlooked an important part of mathematics, namely mathematics as it is exercised by ordinary people (almost everyone without a mathematics degree). I do so by looking at the different theories that have been put forward in the recent debate, and showing for each of these that they are unable to account for the mathematical practices of ordinary people. In order to show that these practices do need to be accounted for, I also argue that ordinary people are (sometimes) doing mathematics, i.e. that they engage in properly mathematical practices. Because these practices are properly mathematical, they should be accounted for by any philosophy of mathematics. The conclusion of my thesis, then, is that current theories fail to do something that they should do, while remaining neutral on how well they perform when it comes to accounting for the practices of professional mathematicians.
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Griffiths, Stephanie. "Evaluating referral appropriateness in primary care extended scope physiotherapists through the development of referral criteria for rotator cuff tears." Thesis, Manchester Metropolitan University, 2013. http://e-space.mmu.ac.uk/315674/.
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Background: The ability of primary care Extended Scope Physiotherapists (ESPs) to refer appropriate patients to secondary care has not been adequately examined. Also referrals for shoulder surgery from secondary care ESPs have been shown to be misdirected in comparison to other specialties. Barriers to referral have not been investigated but the literature suggests that referral criteria may improve appropriate referrals. The high prevalence of rotator cuff disease, its impact on pain and disability, and the lack of agreement between surgeons about when to operate indicate that there is a strong case for the development of surgical referral criteria for rotator cuff tear pathology. Method: The thesis has three stages of study. First a national survey of 99 primary care ESPs was undertaken to determine conversion to surgery rates, barriers to referral and the use of referral criteria. Secondly a national Delphi study with 20 shoulder surgeons was undertaken and surgical referral criteria for rotator cuff tear were developed. Thirdly after development, the criteria were tested on a convenience sample of 9 ESPs using 3 vignette case studies. Results: Primary care ESPs have a mean conversion rate of 74%. There was not enough data to show differences between subspecialist groups. Most barriers to specialist referral were associated with commissioning rather than issues pertaining to the primary care environment. 50% of ESPs reported using referral criteria which may explain why barriers to referral were relatively low. Surgical referral criteria for rotator cuff tear were developed. Key areas of consensus were: severity of pain, functional limitation, identification of fat atrophy and agreement for a trial of physiotherapy before referral. When referral criteria were piloted on a surgical candidate 33% of the ESPs changed their referral behaviour appropriately. Conclusion: ESPs in primary care have shown mean conversion rates of 74%. Surgical referral criteria to improve the appropriateness of rotator cuff tear referrals have shown promising results when piloted. Implications: In future referral criteria may have the potential to improve the appropriateness of rotator cuff referrals and may be beneficial as a benchmark against which ESPs can independently demonstrate the appropriateness and quality of the care they provide.
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Rogers, Michael A. "Tonality and the Extended Common Practice in the Music of Thad Jones." Thesis, University of North Texas, 2015. https://digital.library.unt.edu/ark:/67531/metadc801875/.
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Tonality is a term often used to describe the music of the common practice period (roughly 1600-1900). This study examines the music of mid twentieth-century jazz composer Thad Jones in light of an extended common practice, explicating ways in which this music might be best understood as tonal. Drawing from analyses of three of Jones’s big band compositions: To You, Three and One, and Cherry Juice, this study examines three primary elements in detail. First is Jones’s use of chord-scale application techniques in the orchestration over various chordal qualities represented by the symbols, revealing traditional as well as innovative methods by Jones. Second is Jones’s use of harmonic progressions, demonstrating his connection to past practice as well as modern jazz variations. Third is Jones’s use of contrapuntal connections and their traditional relationship to functional tonality, but in a chromatic scale-based environment. Jones’s music is presented in this study to demonstrate a tonal jazz common practice that represents an amalgamation of traditions including twentieth-century scale-based procedures, Renaissance and early twentieth-century modality, eighteenth- and nineteenth-century voice leading schemas, and Baroque and Classical descending-fifth progressions. Also included as an appendix is a list of possible note errors in the published scores of To You, Three and One, and Cherry Juice.
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Hebert, Robin Lewis. "Initiation of In-hospital CPR: An Examination of Nursing Behaviour Within their Scope of Practice." Thesis, Université d'Ottawa / University of Ottawa, 2017. http://hdl.handle.net/10393/35804.
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Cardiopulmonary resuscitation (CPR) and defibrillation are the interventions performed by health care professionals in order to preserve the life of a patient suffering cardiac arrest. These tasks are important to the role of nurses because they are the most common first responders to in-hospital cardiac arrest scenarios. The early initiation of CPR and defibrillation is essential in increasing the likelihood of a patient surviving cardiac arrest. Despite possessing the knowledge, skills, training, and professional obligation to deploy CPR and defibrillation independently, nurses may hesitate to perform the appropriate actions in a timely manner. This topic has been studied previously; however, there have been no studies directly examining this issue in the Ontario context. This thesis explored the factors that influence the behaviour of nurses in the first responder role by employing a mixed-methods research design. The quantitative portion of the study consisted of a series of scales on an online survey that examined teamwork factors and nurses’ experience with CPR events. The qualitative part of the study consisted of open-ended questions on the survey as well as individual interviews with nurses to understand the barriers and enablers to the role of nurses in the enactment of basic life support (BLS). The qualitative data were analyzed with a modified grounded theory approach. The qualitative data analysis followed the guidelines developed by Charmaz (2006) and employed the conceptual framework on optimizing scopes of practice developed by the Canadian Academy of Health Sciences (2014) to extrapolate findings on the influence of nurses’ scope of practice on their behaviour. This study revealed a number of contextual factors in Ontario influencing nurses’ deployment of CPR and defibrillation including variations in hospital unit types, geography, workload, the availability and quality of technology, legislation and regulation, accountability, as well as economic constraints.
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Brand, Emily Katherine. "Humanistic Vocal Pedagogy: Exploring a Voice Teacher’s Scope of Practice through a Perspective of Wellness." The Ohio State University, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=osu1461093502.
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McLaine, Catherine Clare. "Diabetes and oral health complications: Australian diabetes health care professionals' knowledge and scope of practice." Thesis, Curtin University, 2013. http://hdl.handle.net/20.500.11937/2373.
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The research investigated Australian diabetes health professionals’ (DHPs’) knowledge and their intervention, health promotion, and care management of oral health issues which impact upon the person with diabetes. Results identified the need for enhanced provision of diabetes-specific oral health education, clinical resource tools, and the delivery of oral health services. The findings were discussed within the context of the current health system policies and their impact upon DHPs’ management of diabetes related oral health complications.
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Boyee, Jennifer Kristin. "PRACTICE AND APPLICATION OF KNOWLEDGE BY NUTRITION STUDENTS." UKnowledge, 2011. http://uknowledge.uky.edu/gradschool_theses/122.
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Practice and knowledge of upper‐level human nutrition and dietetics students (juniors and seniors, n=96) attending a midwestern university were compared to their comprehension and application of the Scope of Dietetics Practice. The sample consisted of 96 students, primarily (72%) in the 21 – 23 age category; females made up 83% and males comprised the remaining 17% of the sample. In this sample, 70% of the participants reported dietetics as their current major, and 30% stated that their major was human nutrition. Overall, students majoring in human nutrition responded neutrally to the questions concerning comprehension, knowledge, and implementation of the Scope of Dietetics Practice, while participants majoring in dietetics reported better knowledge, comprehension, and implementation of the Scope of Dietetics Practice. However, students majoring in human nutrition reported increased use of nutrition information to diagnose others than were students studying dietetics. In general, participants responded to questions regarding their practice and application of nutrition knowledge to themselves and others as would be expected, though there were differences between the students studying human nutrition and those studying dietetics.
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Greenwood, Jennifer. "The impact of geography, training, and experience on scope of practice among Certified Registered Nurse Anesthetists." VCU Scholars Compass, 2014. http://scholarscompass.vcu.edu/etd/3440.
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The role of Certified Registered Nurse Anesthetists (CRNAs) in the delivery of anesthesia care is evolving given the recent recommendations for Institute of Medicine and provisions in the Affordable Care Act. Despite rigorous clinical training and consistent outcomes studies to support quality care given by CRNAs, the scope of practice of nurse anesthetists is frequently limited, and they do not practice to the full extent of their education and training. As health care spending becomes more constrained and demand for anesthesia services rises, the role of nurse anesthetists as more autonomous providers of anesthesia may be required to maintain access to quality care in a cost-conscious environment. Understanding the factors that influence one’s decision to engage in a broad scope of practice may guide training and recruiting practices. Using Bandura’s Self-Efficacy Theory as a framework to conceptualize scope of practice, an internet based survey of a cross-section of practicing CRNAs was conducted. Subjects responded to questions to describe the geography of their practice, experience as a civilian or military CRNA, and detailed clinical training variables. A composite score was created to gauge overall quality of clinical training. Each CRNA then rated their global scope of practice using a novel SOP-VAS, from 0-100. 1409 subjects participated in this study, yielding 1202 usable data sets. CRNAs practicing in rural locations exhibited higher mean SOP scores than those practicing in urban and suburban locations (p<0.001). CRNAs practicing in states that had opted-out of physician supervision had higher mean SOP scores (p<0.001). Years in Practice was positively correlated with SOP (p<0.01), however months on active duty in the military as a CRNA did not show a statistically significant correlation with SOP. Gender and the composite quality score also demonstrated a statistically significant affect on SOP. Regression modeling using significant predictors from prior analyses resulted in predictive model to describe SOP (p<0.001). Use of the novel SOP-VAS was found to be a reliable and valid tool to measure SOP among nurse anesthetists. Further study is warranted to identify additional factors that may contribute to scope of practice among nurse anesthetists.
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Suckley, J. E. "Core clinical competencies for extended-scope physiotherapists working in musculoskeletal (MSK) interface clinics based in primary care : a Delphi consensus study." Thesis, University of Salford, 2012. http://usir.salford.ac.uk/26989/.
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Objectives: The primary aim of this UK-based study was to identify core clinical competencies (skills, knowledge, attitudes, and behaviours) for primary-care-based extended-scope physiotherapists (ESPs) working in the field of adult musculoskeletal (MSK) medicine. Although the musculoskeletal (MSK) ESP role in the UK has been in existence for over 10 years, there is no competency and curriculum framework supporting these posts. This study used a consensus-building methodology with a multidisciplinary panel of MSK experts to identify core clinical competencies for MSK ESP practice. Methods: Purposive sampling was used to recruit MSK ESPs and MSK medical experts from six specialist fields within medicine: rheumatology, neurology, neurosurgery, general practice, orthopaedic surgery, and rehabilitation medicine. Seventy-two experts volunteered to take part in a three-round online Delphi survey and fifty-six experts completed all three rounds. Qualitative data from the first and second questionnaire rounds were analysed using content analysis, and descriptive statistics facilitated the presentation of quantitative data. Principal findings: The expert Delphi panellists identified 104 core clinical competencies for primary-care-based MSK ESP practice and they reached a consensus view on 85 competency items. Importance and Relevance: This is the first study to have identified core clinical competencies for primary-care-based MSK ESPs. Although further work is required to validate the results of this Delphi survey, they represent a contribution to knowledge in the field of MSK ESP practice and they should assist the professional body and the health care regulator with their development of a nationally agreed competency and curriculum framework for MSK ESP practice.
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Everall, Philip. "A digital resource for navigating extended techniques on bass clarinet." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2016. https://ro.ecu.edu.au/theses/1940.
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Extended techniques are integral to the creation and interpretation of works for the bass clarinet. Effects such as multiphonics, microtones, or percussive and air sounds, have become commonplace in repertoire from the twentieth and twenty-first centuries. This PhD dissertation posits that the bass clarinet’s affinity for these sounds can be traced back to the instrument’s earliest uses, and thus extended techniques should be central to the understanding of the bass clarinet. While there is a large knowledge-base of these techniques, the paradigm of print resources with accompanying music media in which it is catalogued is old-fashioned and inefficient. This project centres around the creation of a digital resource (an iPad application) that allows performers and composers access to this body of information in a format that is portable, powerful, and intuitive. It strives to organise the information in more efficient and useful ways, to present it elegantly, and to facilitate quick and intelligent methods of retrieval. The app can also be used as an educative tool enabling performers and composers to more quickly obtain mastery of this material. The efficacy of the app is demonstrated through a lecture recital and accompanying exegetical discussion explicating the ways that the app can add (or could have added) value in the composition, notation, learning, and performance of the works presented.
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Bell, Janet. "An investigation into the scope of practice of a registered critical care nurse in a private hospital." Thesis, Stellenbosch : University of Stellenbosch, 2011. http://hdl.handle.net/10019.1/16595.
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Thesis (MCur)--University of Stellenbosch, 2005.ENGLISH ABSTRACT: The critical care nurse works in an environment where patient need often shifts the parameters within which she or he practices. It is expected of a skilled critical care nurse to be able to make independent decisions and take action regarding patient care based on her or his knowledge and skills without discounting the parameters of her or his scope of practice. Practice experience has indicated that the critical care nurse is often uncertain about whether her or his clinical activities are protected by the regulations provided by the Nursing Council. This is more specifically true in the private hospital industry where medical advice or assistance is not always easily available. This situation led to the following research question: Do the available professional and legal guidelines provide an appropriate foundation to guide the practice of the registered critical care nurse in the private hospital sector critical care environment? A non-experimental descriptive study with a qualitative orientation was conducted in 19 private hospitals in the Western Cape. Through nonprobability, random sampling, 71 registered critical care nurses were included in the study. A questionnaire was designed and validated to collect the data. Quantitative data was analysed through Excel® while qualitative data was analysed thematically. It was found that the legal and professional guidelines in place at present do provide a foundation for the clinical activities of critical care nursing in the private hospital sector. It is suggested that it is rather the critical care nurses’ interpretation of the Scope of Practice (No.R.2598 of 30/11/1984 as amended) that limits their practice as opposed to the wording of the regulations. It is recommended that critical care nurses must determine nursing care parameters based on patient need, using the regulations as a foundation for critical, analytical and reflective practice rather than as a set of rules to be followed. Key words: Scope of practice, critical care practice, ICU nursing care, private hospital nursing practice.
AFRIKAANSE OPSOMMING: Die kritiekesorgverpleegkundige werk in ‘n omgewing waar pasiëntebehoeftes gereeld die parameters waarin sy of hy praktiseer, verskuif. Dit word van ’n bekwame kritiekesorgverpleegkundige verwag dat sy of hy onafhanklike besluite en aksies met betrekking tot pasiëntesorg, gebaseer op haar of sy kennis en vaardighede, sal neem sonder om die parameters van haar of sy bestek van praktyk te oorskry. Praktykondervinding het getoon dat die kritiekesorgverpleegkundige dikwels onseker is oor watter van haar of sy optredes deur die Regulasies, soos deur die Raad op Verpleging gespesifiseer word, beskerm word. Dit is nog meer spesifiek van toepassing in die privaathospitaal-industrie waar geneeskundige advies en bystand nie altyd maklik beskikbaar is nie. Die situasie het tot die volgende navorsingsvraag aanleiding gegee: Voorsien die beskikbare professionele en wetlike riglyne ’n geskikte grondslag om die praktyk van ’n geregistreerde kritiekesorgverpleegkundige in die privaatsektor- kritiekesorgomgewing te rig? ’n Nie-eksperimentele, beskrywende studie met ’n kwalitatiewe oriëntasie is in 19 hospitale in die Wes-Kaap onderneem. Deur nie-waarskynlikheids-, toevallige steekproefneming is 71 geregistreerde kritiekesorgverpleegkundiges in die studie ingesluit. ’n Vraelys is ontwerp en gevalideer om inligting in te samel. Kwantitatiewe data is deur middel van Excel ontleed terwyl kwalitatiewe data tematies ontleed is. Daar is gevind dat die wetlike en professionele riglyne wat tans beskikbaar is, ‘n grondslag bied vir die kliniese aktiwiteite van kritiekesorgverpleegkundiges in die privaathospitaal.. Dit word voorgestel dat dit die kritiekesorgverpleegkundige se interpretasie van die Bestek van Praktyk (No.R.2598 of 30/11/1984 soos aangepas) is wat hulle praktyk beperk, eerder as die bewoording van die regulasie self.
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Yeh, Yi-Lien. "An investigation of Taiwanese teachers' experience, beliefs and practice in piano teaching : exploring the scope for creativity." Thesis, University of Exeter, 2014. http://hdl.handle.net/10871/16572.
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This study aimed to explore Taiwanese piano teachersâ beliefs about good teaching, and their practice, particularly teachers who teach beginners or young children; and to gain understanding of how Taiwanese piano teachers perceive creativity in their teaching. The perceptions of piano teaching of seven Taiwanese teachers were explored through using a qualitative methodology, which included an open questionnaire, two interviews separated by observation of classroom practice, and a reflective diary prepared by the participants which was facilitated by video-stimulated recall. The principal areas and findings of my research were that Taiwanese piano teachersâ beliefs about what constituted good lessons are diverse. These were explored from three perspectives, namely, the characteristics of effective teachers, the components of effective lessons, and effective teaching strategies. The participant teachersâ attitudes towards creativity in teaching were also different, and can be categorised as ranging from fixed and rigid, to flexible and open. They identified several teaching strategies as creative teaching, such as using metaphor, storytelling, and Internet resources. Additionally, their various purposes in using creative teaching were observed to be to develop learnersâ musical abilities; for enjoyment; and to impart a specific teaching point. Although the teachersâ own experiences were found to have a positive effect on their teaching beliefs, the influence of these benefits was not always evident in their actual practice. Pupilsâ low motivation to learn and insufficient practice were considered as the common challenges and, when reflecting on their own teaching in the second interview and in the diaries, most of the participants focused mainly on analysis of pupilsâ playing errors, and tended to believe that repeated practice by the learners was the best approach to improving performance. In contrast, two teachers believed their expertise in both music and teaching could help their learners to deal with learning difficulties. Based on these research results, I conclude that creativity in piano lessons can be understood from two perspectives. The first relates to how teachers perceive their own teaching and whether they are content with what they do or seek to develop their teaching competence; the other is associated with teachersâ own philosophy of the function of education, which affects how teachers develop their teaching.
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Towne, Michael Richard. "Developing extended communities of practice to support implementation of Inspiration® in elementary classrooms." CSUSB ScholarWorks, 2004. https://scholarworks.lib.csusb.edu/etd-project/2637.
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This project examined the need for continuing education for teachers, particularly in the area of technology integration. It includes an exploration of the interdependence of technology and pedagogy. It developed an on-line extended community of practice to support professional educators attempting to implement Inspiration®, a commercial software application. The project presents a research-based justification for employing cognitive mapping strategies in a wide variety of pedagogical contexts, provides a dynamic list of examples demonstrating concrete applications which are connected to content and technology standards, and examines current design features for websites.
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Reid, Doreen. "A prospective policy analysis of the elimination of the exclusive scope of practice from the Nursing Profession Act." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp04/nq39615.pdf.
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Botieff, Jane D. "Flute extended techniques| A practice guide and analytical study of "Hatching Aliens" by Ian Clarke." Thesis, California State University, Long Beach, 2015. http://pqdtopen.proquest.com/#viewpdf?dispub=1592498.
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Extended techniques play an important role in flute repertoire today, as composers continue to explore the possibilities of the instrument in ways not previously done before the mid-twentieth century. Pioneers of flute extended techniques, including Edgard Varèse, Luciano Berio, and Robert Dick, have all played an important role in the progression of flute repertoire leading into the twenty-first century.
Ian Clarke, a British flutist and composer, uses extended techniques as a vital element in his compositions, and has gained a great deal of attention for his breadth of work, including one of his more recent compositions, Hatching Aliens. First published in 2010, this work utilizes a vast amount of extended techniques, all of which contribute to the eerie and mysterious qualities of this programmatic composition for flute and piano. This project report studies the notation and production of extended techniques and how Clarke incorporates them into his composition, Hatching Aliens.
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King, Rachel E. "Processes of 'positive multiculturalism' in practice : an extended case study with Warwick Arts Centre (WAC)." Thesis, University of Warwick, 2013. http://wrap.warwick.ac.uk/58049/.
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This thesis consists of three distinct but interconnecting case studies that took place between 2007 and 2010 in collaboration with Warwick Arts Centre (WAC), Britain’s second largest multi-arts venue. The study developed practice-led methods to investigate the dynamic interactions between notions and perceptions of ‘multiculturalism’ and ‘internationalism’ in relation to WAC’s theatre and performance programming and education activities. The first case study is a qualitative audience reception study designed to make sense of WAC’s programme in relation to multicultural and international issues. The second case study focuses on an educational outreach project that placed two local schools in collaboration with a commissioned teacher-artist and a University of Warwick academic. These encounters inspired the final case study, which made use of WAC’s newly built Creative Space as a site for a devising project with young people from nearby Coventry, culminating in a performance for an invited audience. The thesis explores the varied complexities that frame ‘multiculturalism’ by focusing on its origins as a political concept in post-1945 Britain and its subsequent association with contemporary contentious social, political and cultural national and international issues. An analysis of the negative effects of ‘multiculturalism’ is balanced by considerations of the project’s emergent concepts: ‘hospitality’ and ‘conviviality’, which articulate the possibilities of living in diversity in more ‘positive’ terms. These paradigms reverberate throughout each case study, informing their methodologies, influencing their conceptual frameworks and placing ‘multiculturalism’ in more dynamic and relevant dimensions of pedagogical and creative practices. Each case study considers collaboration between strangers and investigates the potential of WAC as a hospitable and convivial environment. These new perspectives demonstrate the optimistic possibilities of creative and humane action for producing a ‘positive multiculturalism’.
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Winstone, Julie. "Extended practice at bingo : an examination of the effects of skilled performance on age-cognition relations." Thesis, University of Southampton, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.400546.
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Au, Chun-lam Antony, and 歐浚林. "A framework of credentialing and defining scope of practice in healthcare providers for colonoscopy and its applicability in Hong Kong." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2014. http://hdl.handle.net/10722/207969.
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Introduction: In recent years, the incidence of colorectal cancer in Hong Kong has risen to become the most frequent cancer type whereas its mortality ranks second. As effective screening is demonstrated to improve survival outcomes, the government in response proposed a mass population colorectal cancer screening program for high-risk groups; screening methods include fecal occult blood test, flexible sigmoidoscopy, and colonoscopy. Because colonoscopy is a highly operator-dependent and is therefore very prone to human error, processes to ensure it is performed safely include credentialing and defining scope of practice. As this concept is relatively new in Hong Kong, this study aims to investigate its applicability specific to colonoscopy in the city’s medical profession through determining competency indicators in the procedure.
Methods: A systematic review was performed using online databases—PubMed and Google Scholar—to retrieve sources of information. Aside from academic research, guidelines from professional associations from three countries were also incorporated in this paper; they are the Gastroenterological Society of Australia, the Canadian Association of Gastroenterology, and the American Society for Gastrointestinal Endoscopy.
Results: Technical aspects for competency include a mean withdrawal time of over 6 minutes;; first time examination adenoma detection rate of ≥ 25% and ≥ 15% in asymptomatic men and women ages > 50, respectively; ≥ 90% cecal intubation rate in all cases; perforation and post-polypectomy bleeding complication rates at < 1/1,000 and < 1/100 cases respectively;; and annual volume rates between 100 to 150 procedures. Experience is a significant factor in improving technical competency. Cognitive competency include correctly identifying and managing abnormalities, and knowledge of appropriate patient indications and contraindications for screening colonoscopy, risk management, and intervals for the procedure. .
Conclusion: Guidelines recommend annual volume rates to be used as the primary indicator of technical competency, whereas the minimum medical academic qualification is recommended to have residency in endoscopic surgery. As colonoscopy is provided in both the public and private healthcare sector, the credentialing committee should have authority to influence colonoscopy providers in both sectors. A suitable agency is the Hong Kong Academy of Medicine, as they accredit specialists, and colonoscopy overseas is typically performed by endoscopists having received specialty training.published_or_final_version
Public Health
Master
Master of Public Health
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DiChiacchio, Toni. "An Evidence Based Web Intervention to Facilitate Nurse Practitioner Participation in the Policy Making Process Related to Scope of Practice." Thesis, West Virginia University, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3618096.
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Historically nurses have been strongly engaged in the political process, however in recent decades the profession has moved away from the policy arena. Without political engagement, issues that are important to the nursing profession are not addressed timely, if at all. One such issue is that of full practice authority for advanced practice registered nurses (APRNs). Well over 100 studies have been completed over the past 40 years showing the safe and quality care APRNs provide independently. Numerous well-respected, non-nursing organizations support the removal of state laws that impede the ability of APRNs to practice to the full extent of their education and training, particularly in light of the looming extinction of primary care physicians and the simultaneous increase in demand for primary care services (American Association of Retired People, 2011; Federal Trade Commission, 2012; Institute of Medicine, 2010; National Governor's Association, 2012). The purpose of this capstone project was to provide a website in which APRNs and APRN students could communicate quality information to legislators in support of full practice for APRNs in West Virginia during a legislative session in which a full practice bill was introduced. Website visitors who were APRNs or APRN students were asked to complete a survey on the website comparing their communication with legislators last year to their communication or intended communication, after they had been introduced to the website, during the current session. Findings included a strong statistical association between use of the website and communication with legislators along with a statistical association between use of the website and conveyance of quality information supporting full practice authority. The findings suggest that websites related to specific nursing issues could be a method to increase political involvement of nurses.
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Shin, Hyun Kun. "The nature and scope of Eastern thought and practice in contemporary literature on American physical education and sport (1953-1989) /." The Ohio State University, 1990. http://rave.ohiolink.edu/etdc/view?acc_num=osu1487677267728948.
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Salako, Abiodun. "The impact of state nurse practitioner scope-of-practice regulations on access to primary care in health professional shortage areas." Diss., University of Iowa, 2019. https://ir.uiowa.edu/etd/7025.
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Primary care physician (PCP) shortages have been a barrier to accessing care for millions of Americans, particularly those living in areas facing the worst shortages - primary care health professional shortage areas (HPSAs). Increased use of nurse practitioners (NPs) has been proposed as a solution to the shortages as NPs can effectively substitute for PCPs. However, this proposal has been hampered by regulatory restrictions on NP scope-of-practice (SOP) that exist in many states. While some states permit NPs to practice and prescribe medications independent of physicians (NP independence), others require extensive physician supervision that limit NPs ability to provide care and substitute for PCPs. Despite the limitations that restrictive regulations pose to improving access to primary care, research evidence of their effect on access in primary care HPSAs is limited. This dissertation fills this gap in the literature.
Using individual-level data from the Medical Expenditure Panel Surveys (1996-2015) and a difference-in-differences approach, I exploit variation in NP independence across states and over time to evaluate the impact of NP independence on access to primary care in HPSAs Further, I examined for heterogeneity in the effect of NP independence between HPSAs and non-HPSAs as well as effect heterogeneity in HPSAs based on individual (age, insurance status, and insurance type) and health system characteristics (availability of primary care facilities and NP Medicaid reimbursement rate)
I find that NP independence led to a 5% increase in the number of individuals with a primary care provider and a 2% increase in the use of non-physicians (relative to physicians) as the primary care provider in HPSAs. However, non-HPSAs experienced no significant changes in access to care. Further, I find evidence of heterogeneity in the effect of NP independence in HPSAs for all three individual characteristics but find no significant effect heterogeneity for any of the health system characteristics. Non-elderly individuals experienced greater improvements in access following NP independence compared to their elderly counterparts, and while both insured and uninsured individuals experienced improvements in access to care, uninsured individuals benefitted more from NP independence. Further, I find evidence of greater improvements in access to care among Medicaid beneficiaries relative to their privately insured and Medicare counterparts.
These findings imply that removing regulatory restrictions on NP SOP could be an effective policy strategy for mitigating the effects of PCP shortages and improving access to care in HPSAs. Further, they demonstrate that NP independence could be a viable tool for addressing access to care issues in two traditionally underserved populations – the uninsured and Medicaid beneficiaries. Beyond addressing access issues, NP independence could also mitigate rising health care costs. The finding of increased use of lower-cost non-physicians rather than their more costly physician counterparts after NP independence indicates that this policy change could also bring about cost savings for society.
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Mullah, Moonira. "A survey of the working environment of medical technologists in South Africa." Thesis, Cape Peninsula University of Technology, 2018. http://hdl.handle.net/20.500.11838/3081.
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Thesis (MSc (Health and Wellness Sciences))--Cape Peninsula University of Technology, 2018Biomedical Laboratory Technologists play a fundamental role in the diagnosis of disease in patients. Their role in South Africa is currently undergoing profound changes with an emphasis placed on a four-year professional degree that will replace the National Diploma in Biomedical Technology at most Universities of Technology and Comprehensive Universities (UJ and NMU) by 2020. Training and competency programs, along with the retention of experienced staff, remain key in providing accurate laboratory results. It is therefore imperative to investigate this field in factors related to training, work experience and job satisfaction. This study aimed to evaluate the perceptions of Medical Technologists and Medical Technicians with regards to salary, interpersonal relationship, continuing professional development (CPD), work ethic and scope of practice within the profession. A mixed methods study was conducted to evaluate salary, career choice happiness and CPD compliance of Medical Technologists and Medical Technicians, as well as their perceptions around interpersonal relationships, work ethic and scope of practice. In sampling, a convenience sample was identified, after which a snowballing method was used. A link to a web-based survey was distributed to a group of Medical Technologists and Medical Technicians who attended the Society of Medical Laboratory Technology of South Africa (SMLTSA) Medical Laboratory Professionals congress. This congress was held in 2015 in Port Elizabeth, South Africa. A sample of 144 Medical Technicians and Medical Technologists was obtained, of which 98.6% were registered with the Health Professions Council of South Africa (HPCSA). Only 54.2% were active members of the Society of Medical Laboratory Technologist of South Africa. Age (r = 0.674, p < 0.05) and years worked at current employer (r = 0.533, p < 0.05) proved to have stronger relationships with salary than education (r = 0.195, p < 0.05). Those employed in the public sector earned significantly lower salaries than those in any other sector (p < 0.05), with the exception of those working in independent practice. Both Medical Technologists (44.2%) and Medical Technicians (34.4%) perceived that they did not receive the respect they deserved from Pathologists in their working relationship. In addition, 31.3% of Medical Technicians perceived that their roles were regarded as of lesser value, and that their knowledge, training and attained qualifications were not recognised by the Pathologists. Despite this, this study concluded respondents were generally happy with their career choice, as 71.9% of respondents reported. Findings of this study serve as a strong foundation for additional research on the topic of career happiness versus job satisfaction and retention of staff in medical diagnostic laboratories.
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Rees, Carla. "Collaboration in practice : developing a repertoire of extended techniques for the Kingma System alto and bass flute." Thesis, Royal College of Music, 2014. http://researchonline.rcm.ac.uk/385/.
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This doctoral research explores the benefits of the Kingma System as applied to the alto and bass flute. It demonstrates each instrument's potential for the use of extended techniques and the way in which these techniques are applied to the repertoire. The research takes places within the context of my own personal practice as a recitalist and chamber musician, and is represented through recordings of a selection of the repertoire and a website for each instrument, as well as a written commentary. The discussion of repertoire focuses on case studies selected from over 75 works composed for me using these Kingma System instruments. These case studies are presented through recordings, as well as in a detailed discussion of the use of specific aspects of the instruments' capabilities, including multiphonics, microtonality, alternate fingerings, tone colour, articulation and other extended techniques. The approaches of different composers regarding the notation of these techniques within the repertoire are also explored, and the practical information arising from these case studies is presented as a reference guide for composers and performers in website form. These websites can be found at www.altoflute.co.uk and www.bassflute.co.uk, and include multimedia demonstrations, fingering charts and notational examples. Much of this information is being made available for the first time, and includes the most extensive published selection of multiphonics and trill fingerings for the alto and bass flute. This is also the first survey of extended techniques that is specifically dedicated to instruments enabled by the Kingma System.
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Krogue, Paul Anthony, and Paul Anthony Krogue. "Barriers to Practice: Understanding Phsyician and Hospital Administrator Knowledge, Beliefs, and Attitudes of the Role and Scope of Practice of Acute Care Nurse Practitioners in the Acute Care Setting in Rural Montana." Diss., The University of Arizona, 2018. http://hdl.handle.net/10150/626676.
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Purpose: to describe the knowledge, beliefs, and attitudes of physicians and hospital administrators regarding the role and scope of practice of acute care nurse practitioners in rural Montana.
Background: Nurse practitioners have been increasingly called upon to provide high quality and cost-effective healthcare in variety of settings and have consistently shown to provide a high-level of patient care in both the primary and acute care settings. The acute care nurse practitioner specialty is relatively new, and with very few licensed acute care nurse practitioners in the state of Montana, the role and scope of practice is not well understood by physicians and hospital administrators who are often tasked with hiring and recruiting providers in the hospital setting. The Consensus Model, which served as the conceptual framework for this project, advocates that nurses provide care for the population that is specific to their licensure, accreditation, certification, and education.
Method: Some 28 physicians and hospital administrators completed a survey that included 21 Likert scale statements that were divided into the subscales of Knowledge, Belief, and Attitude.
Results included: 1) An existing gap in knowledge regarding the role and scope of practice of acute care nurse practitioners, 2) acute care nurse practitioners should always have some form of physician oversite, and 3) there is disparity in patient outcomes when patient care is provided by nurse practitioners.
Conclusion: Attitudes of survey respondents were overwhelmingly positive for the future of acute care nurse practitioners filling various provider roles in the hospital setting. These results can provide a foundation for future inquiry and can assist in the development of education and collaborative efforts to further advance the utilization of acute care nurse practitioners in Montana.
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Kurtzman, Ellen T. "Delivery of High Quality Primary Care in Community Health Centers| The Role of Nurse Practitioners and State Scope of Practice Restrictions." Thesis, The George Washington University, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=3746006.
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In response to the increased demand for primary care in the United States—a byproduct of a growing elderly population and insurance expansion under the Affordable Care Act (ACA)—the total number and capacities of community health centers (HCs) is expected to grow. While HCs have historically depended on physicians to deliver the majority of their care, more and more, they are shifting to non-physician clinicians, especially nurse practitioners (NPs); yet, little is known about the quality of care delivered by NPs in HCs or about the role state occupational restrictions have on these practitioners or their patients.
Using quasi-experimental methods and data from the community health center subsample of the National Ambulatory Medical Care Survey (NAMCS), this dissertation explores three distinct, but related, research questions regarding NP-delivered care in HCs—its effectiveness and comparability to physician care, the extent that tradeoffs in the quantity and quality of care are made, and the real-world risks and benefits of states easing their scope of practice restrictions. Findings, which suggest that NP care is comparable to physician care in most ways and that the quality of NP-delivered care does not significantly vary irrespective of states’ NP independence status, have important implications for policy and practice.
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Downing, Dirk M. "Staying in the Sweet Spot| How Elite Level Golfers Engage in, Structure, and Experience Practice Throughout Extended Careers." Thesis, University of Missouri - Columbia, 2019. http://pqdtopen.proquest.com/#viewpdf?dispub=13877141.
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The path to expertise has been quantified on several occasions (Ericsson, Krampe, and Tesch-Römer, 1993; Ericsson 2001; Ericsson & Charness, 1994; Ericsson 2008) as well as explored through qualitative retrospective methods (Bloom 1985; Kreiner, Phillips, & Orlick 1993; Hayman et. al. 2014). However, little research has investigated the experience of elite performers as they attempt to maximize their performance over time. The purpose of this study was to examine how elite golfers think about, structure, and experience practice intended to maximize performance throughout a long career.
The researcher utilized a phenomenological approach to explore the lived experience of five PGA Tour players as they reflected on their practice experience thus far. The central themes found were: a) tailoring practice, b) achieving balance, c) staying engaged, d) being proactive. The core thematic findings spring from two results: 1. The most effective practice for elite golfers are highly individualized, and 2. effective practice for these players is reached when they proactively tailor their approach to pursue appropriate balance and achieve consistent engagement. These findings may benefit golfers, golf coaches, and applied sport psychology practitioners. Theoretical implications and possibilities for future research are discussed.
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Tovey, Philip Noel. "The theory and practice of extended communion, with particular reference to parishes within the Anglican Diocese of Oxford." Thesis, Oxford Brookes University, 2006. https://radar.brookes.ac.uk/radar/items/2099a75e-9861-408b-9329-e2bac8986503/1/.
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The Roman Catholic Church, the Methodist Church, and the Church of England recently introduced a service of 'extended communion',which is the distribution of previously consecrated elements by lay-people to congregations, in the absence of a priest This has been a highly controversial service, many theologians being against it, while at the same time policy-makers having to introduce the service. It is justified in part by reference to patristic precedent and to pastoral need, which raises significant theoretical questions about the relationship of theory and practice. This thesis analyzes the introduction of this service, particularly in relation to the changing context for the church, and the declining numbers of clergy. Policy-maker's assumptions are identified as hypotheses to test The research then conducts a small-scale qualitative research project in the Diocese of Oxford to uncover and evaluate significant issues in practice. This part of the thesis, tests the ten hypotheses previously identified, and discovers and evaluates the development oflocal theology, previous research not having included this level of theological debate. 32 interviews in six parishes were conducted, as well as observational research and documentary analysis. The research challenges the assumption that extended communion is primarily a rural phenomenon, and the evidence uncovered suggests that the principal usage is clergy cover, whatever the espoused theory. This gap between theory and practice is developed into a methodological debate about the relationship between empirical research and theological enquiry. A model is created which gives a priority to revelation, but acknowledges its interpretation as provisional, and allows a challenge to theology from empirical findings.
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Dimitrov, Valeri. "Article 13 of the ECT in practice and its role in expropriation disputes : What is the scope of Article 13 of the ECT with respect to expropriation disputes?" Thesis, Uppsala universitet, Juridiska institutionen, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-384439.
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Creegan, Peter. "An interpretative phenomenological study exploring the experiences of extended scope physiotherapists : does viewing them as institutional entrepreneurs engaged in institutional work provide an understanding of these experiences?" Thesis, University of Huddersfield, 2017. http://eprints.hud.ac.uk/id/eprint/34137/.
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Objectives: To understand the experiences of physiotherapists as Extended Scope Practitioners (ESPs) working in acute NHS hospitals using the concepts of Institutional Entrepreneurs engaged in Institutional Work. Design: A qualitative study using an interpretative phenomenological framework. Methods: In depth, semi-structured interviews which were analysed thematically using the steps suggested by Van Manen (1992). Themes which emerged represented the experiences of all the participants. Once the themes were identified the concepts of Institutional Entrepreneurs and Institutional work were applied to provide an understanding of the ESPs` experiences. Participants: 12 ESPs from three acute hospitals from a variety of clinical specialties (2 gynaecology, 3 neurology, 2 orthopaedics, 2 paediatrics, 1 pain management, 1 cardiology, 1 respiratory). Results: The first theme identified the motivation of the participants to extend their remit and create opportunities for the new role. The impact of this, for some participants, was a confused professional identity not aligned with physiotherapy. They felt different to physiotherapists in the way they thought clinically and their methods of practice. This manifested itself in their refusal to wear a uniform. The second theme explored negotiation and agreements of clinical boundaries between the participants, consultants, managers and other clinical staff. The ESPs were proactive and astute basing their actions on both a professional and business logic. They knew when to propose or create an opportunity, when to consider alternatives and when not to act based on the professional relationships with other professions, NHS pressures or likelihood of success. The final theme identified the adaptive nature of ESP roles. The participants were sensitive, and felt vulnerable, to NHS change. They voiced concerns over the sustainability of such posts in terms of succession planning and a lack of framework to develop such roles in the future. Using the typography of Institutional Work provided an understanding of the ESPs` experiences. It identified successful and less successful types of work and enabled discussion on what can be achieved at the micro, individual level, what needs input from the macro, profession level and how the two can support each other. It also identified weaknesses to be addressed that would benefit the professions development. Conclusion: The results from this study address the dearth of literature on the experiences of ESPs and provides details which will have resonance with physiotherapists and insight for other professions. It is recommended that a more robust ESP professional network, to champion and diffuse new practice into the NHS, is needed. Secondly there is a need for a recognised and nationally validated education programme for extended practice. This study refines the institutional work concept and highlights the inter-relationships between diverse types of work. It challenges the assertion of a sequential order of institutional work and illustrates how individuals embedded in the institutions of the NHS and physiotherapy can stimulate change through strands of institutional work that are sympathetic to the workplace environment and culture. This study provides empirical evidence that institutional work is performed by ordinary individuals which can diffuse through a profession. In doing so it provides insight for physiotherapists and other professions as to ways and means this can be achieved.
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Miguel, Mariana da Silva. "Experimental creative practice at the piano: a case study." Master's thesis, Universidade de Évora, 2021. http://hdl.handle.net/10174/29942.
Full textAbstract:
This document focuses on the development of an artistic practice-based research project focused on
active experimentation and the development of creativity at the piano. The experimentation process
relies on the exploration of extended and prepared piano techniques, which are described throughout
the text, as well as on the use of electronics. The creative process involves the composition of a musical
piece (Become One) inspired mainly by Music for 18 Musicians, by Steve Reich, its structure,
instrumentation and compositional processes. The purpose of this project is to reflect on the work of
authors such as Dewey (1934), Shockley (2018), Vaes (2009) and Mayas (2019), and relate it to the
documentation of these processes, hence fostering future creative and experimental practices in
other performers; Prática criativa experimental ao piano: um estudo de caso
Resumo:
O presente documento foca-se no desenvolvimento de um projecto de investigação artística baseado
na experimentação e no desenvolvimento da criatividade ao piano. O processo de experimentação
está centrado na exploração de técnicas expandidas e de piano preparado, descritas ao longo do texto,
assim como na utilização de electrónica. O processo criativo envolve a composição de uma obra
musical (Become One), inspirada maioriatiamente em Música para 18 Músicos de Steve Reich, a sua
estrutura, instrumentação e processos de composição. O propósito deste projecto centra-se na
reflexão do trabalho de autores como Dewey (1934), Shockley (2018), Vaes (2019) e Mayas (2019),
relacionando-a com a documentação dos processos criativo e de experimentação, promovendo a
replicação de práticas idênticas por parte de outros instrumentistas.
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Pilon, B., D. Link, T. Hansen-Turton, and Patricia M. Vanhook. "The Importance of Association: How a Nursing Focused Foundation and Associations Led the Charge to Greater Autonomy and Expanded Scope of Practice." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/7426.
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Bonenfant, Yvon Rud Barton. "Immersive intensities and trans-disciplinary adventure : extended voice, tactility and poly-artistic practice from the living to the dead." Thesis, University of Winchester, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.549699.
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This submission for Doctor of Philosophy by Work in the Public Domain brings together a wide variety of creative outputs which sit alongside a number of peer-reviewed, published articles and writings and a published artists" book. These linked with one another via an accompanying text. Together, these elements form and chart a cohesive research-through-creative-practice trajectory. The contents are framed by an argument that the contents of the submission must all be treated as creative practice outputs. This argument is situated within affinities among Arlander"s (2008) and Kershaw"s (2009) appellation "artistic research", as related to Miereanu"s (2009) argument that artworks themselves contain specific knowledge that it is our job to engage with and decode; this suggests these know ledges are what art-making in academia has to offer the other disciplines. The body of the submission elucidates these knowledges by positing the works as varied, experimental manifestations of the notion of bioemotional activism in performance. The works test the tenets of bioemotional activism - conjugating principles from Gerda Boyesen"s biodynamic psychology, extended voice practice, and compositlonal/devlsing practices for sound, body and image - within a framework that extends them across media. It also extends them into dialogues with other artists and disciplines, including painting, video art, dance/choreography, street art, costume and other areas. The overarching concern is to explore the application of a haptic, bioemotional strategy for working with extended voice in performance composition and realisation to experiments with the vocally haptic, confrontations with engagements among voice visual art and tactile art, and confrontations with digital and other archiving technologies. In so doing, the works embody the results of how this approach to extended, extra-normal voice, when voyaging across what Mieranu calls "poly-artistic" (2009) territories, confronts technologies of mediation and in so doing, migrates from the realm of the lived body to dialogue with the absent and the gone; indeed, the "dead". The works included here thus elucidate the results of the experiments and demand to be read as forms of embodied theory.
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Tomei, Joseph George. "Using multimodal extended metaphor prompts to induce the production of figurative language in low-intermediate Japanese learners of English." Thesis, University of Birmingham, 2018. http://etheses.bham.ac.uk//id/eprint/8108/.
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It has been over 35 years since the publication of Reddy's 1979 study of the metaphors for communication, an article that could be said to mark the starting point of Conceptual Metaphor Theory. However, despite the understanding that metaphor and figurative language are fundamental to language, in that time there has been little progress in introducing metaphor into the L2 classroom, especially at lower levels. This thesis argues that learners at this level have figurative resources that have not yet been acknowledged, but could be key elements in developing an L2 metaphor pedagogy. To explore this possibility, a mixed methods investigation of the effect of mutimodal writing prompts based on extended metaphors was conducted with two cohorts of low-intermediate Japanese university students. The mixed methods data analysis revealed not only that the presentation of one extended metaphor could 'activate' metaphorical knowledge of other extended metaphors and induce the production of metaphoric language, but that multimodal material provides an as yet unexploited resource for an L2 metaphor pedagogy.
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Wagh, Prabhanjan B. "An Investigation of Current Practice in the Design of all-Bolted Extended Double Angle Connections in a Beam-to-Girder Connection." University of Cincinnati / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1446547172.
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